Overview of the Systemic Lupus Erythematosus (SLE)

Systemic lupus erythematosus is the most known kind of lupus. It is an autoimmune disease in which the immune system strikes its own tissues, inflicting extensive inflammation and tissue injury in affected organs. It affects the joints, skin, brain, lungs, and kidneys. Lupus doesn`t have a cure, however medical interventions and lifestyle changes helps contain it. ('Systemic Lupus Erythematosus (SLE) | CDC', 2018)

The CDC Lupus registries estimates that a yearly prevalence from 2002–2004 was much higher for blacks than whites in Michigan and Georgia and a yearly prevalence from 2007–2009 for American Indians was a hundred and seventy-eight per one hundred thousand people.

Locally, In Trinidad, a high percentage of patients were of East Indian origin. Of the 169 patients, 91 were confirmed with SLE. (Conyette et al, 2019)

Etiology

The history of lupus is arranged in classical, neoclassical, and modern period.

The Classical period was marked by the primary illustration of the cutaneous disorder. Physician, Rogerius, thought that lesions caused by lupus appeared like wolf bites, thence lupus meaning wolf in Latin (Jewett-Tennant, 2019).

The Neoclassical period is the description of the disease’s systemic/disseminated manifestations. A claim was created that there have been two kinds of the sickness; SLE and discoid lupus.

The modern period was marked by the finding of the LE cell once researchers discovered that the cells in the bone marrow of patients with acute disseminated LE. (Jewett-Tennant, 2019)

The cause of SLE is unknown however multiple factors are linked with the development of the illness, including genetics, ethnics, immunoregulatory, hormonal, and environmental factors (M Bartels, 2019). Some potential triggers may include:

• Sunlight: Exposure can bring on lupus skin lesions
• Infections: This can commence lupus & even cause a deterioration in some persons.
• Medications: It may be activated by specific forms of BP medications, anti-seizure medications or antibiotics. (Lupus - Symptoms and causes, 2020)

Clinical Manifestation

Constitutional manifestations: Patients may present with a variety of systemic manifestations. Symptoms may include: fever, myalgias, headache, and loss of appetite/weight. The typical symptoms are nonspecific fatigue, fever, arthralgia, and weight change/s. Fatigue, the common symptom may be due to medications, lifestyle patterns and/or affective disorders. Fever, could result from active infection and drug fever. These symptoms may impersonate other infectious diseases & endocrine abnormalities. (COJOCARU & Doina VRABIE, 2011)

Musculoskeletal manifestations: Joint pain is the most common reasons for the clinical presentations in patients with SLE. Arthralgia, arthritis & myopathy are principal manifestations. These symptoms may be mistaken for a different form of inflammatory arthritis and can precede the diagnosis by months or even years. Arthralgia, myalgia, and frank arthritis could involve the mini joints of the hands, wrists, and knees. (COJOCARU & Doina VRABIE, 2011)

Dermatological manifestations: Cutaneous manifestations of SLE comprises of four diagnostic criteria.

The first is malar rash, which can be specified by a rash over the cheeks and nasal bridge. It lasts from days to weeks and usually painful.

The second is photosensitivity, which might be evoked from patients who are questioned if they have any strange rash/symptoms increasing after sun exposure.

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The third may be a discoid rash. Discoid sores often also evolve in sun-exposed areas but are plaque like and with scarring.

The fourth is Alopecia. It creates a patch like pattern of hair loss. (COJOCARU & Doina VRABIE, 2011)

Renal manifestations: Renal failure and sepsis are two fundamental drivers of death in patients with SLE. Glomerular disease usually advances within the first years of having SLE and is asymptomatic. Nephrotic disorder may cause edema and weight gain. Lupus nephritis is a typical indication of SLE. It is brought about by the overthrow of immune complexes. (COJOCARU & Doina VRABIE, 2011)

Pathophysiology

Immune reactions against endogenous nuclear antigens are attributes of SLE. Autoantigens discharged by apoptotic cells are introduced by dendritic cells to T cells prompting an activation. The activated T cells help B cells emit antibodies to self-constituents by producing cytokines for instance, interleukin 10. Additionally, to the antigen-driven T cell-dependent production of autoantibodies, information supports that T cell-independent mechanisms of B cell stimulation via combined B cell antigen receptor and TLR signaling. The pathogenesis of SLE involves a number of cells and molecules which engages in apoptosis, intrinsic and adaptive immune responses. (Bertsias & Cervera, 2012)

The impact of SLE on the body

Circulatory system: Lupus grows chances of heart diseases and stroke. It is due to the long-term inflammation that accompanies lupus. Medications such as steroids raises dangers. Lupus causes inflammation of the heart which causes sharp pains in the chest.

Respiratory system: Lupus puts you at a greater risk of developing infections and getting pneumonia. It may inflame the lining of lungs; the lungs may bloom scarring from inflammation and cause a shortness of breath.

Integumentary system: People with lupus experience skin issues during the journey of their disease. Symptoms may vary depending on the type of lupus or how active it is. There may be a sensitivity to ultraviolet rays from sunlight which can cause changes to the skin. Red, scaly bumps/patches can develop around the body. Discoid lesions may surface on body/scalp. (How Lupus Affects Your Body, 2019). Skin problems in other parts of the body may include:

• Mouth/Nose sores
• Alopecia
• Blue fingers and Toes (cold environments)

Kidneys: The kidneys may be inflamed resulting in indefinite damages. It may lead to swelling in legs and a high BP. It can even lead to kidney failure which may require dialysis.

Brain and CNS: Lupus affects brain and nerves in the spinal cord in various ways:

• Clouded thinking/Memory loss
• Headaches
• Depression/anxiety
• Seizures

Eyes: The main eye problem is dryness. Occasionally blood vessel changes in the retina weakens vision. Lupus can damage nerves in muscles that control eye movements.

Joints and Muscles: Joint pain, swelling, and stiffness are problems with lupus, mostly in hands, wrists, and feet.

Treatments

Medical Management: The goal of SLE is to cease disease activity without long-term use of more than 5 mg prednisolone/day. The measures include hydroxychloroquine as well as protection from sunlight and vitamin D interchange. Patients suffering may need a lot more vaccinations than the healthy population and management of risk factors for atherosclerosis is demanding for long-term survival. Methotrexate is on par with azathioprine. If disease activity cannot be controlled in this way, belimumab is a therapeutic option. Cyclophosphamide is used but mainly in life-threatening situations such as lupus nephritis. Off-label mycophenolate mofetil can be used for lupus nephritis and off-label rituximab in refractory disease courses. (M, 2016)

Nursing Management: Persons affected by lupus and whose families are in need of help in apprehending the condition and requires support as they deal with fear and depression. Suggestions for nursing includes patient/family education about medications, energy conservation, pain/stress management, and coping techniques. (SB, 1992)

Other

Interesting facts about SLE:

• The Lupus Foundation of America approximates that at least 1.5 million Americans and about 5 million people global have lupus.
• It happens mainly in women of childbearing age. Nonetheless, children and men can also have lupus.
• Ninety percent of persons living with lupus are females. The age range of the disease is between 15-44.
• There are at least 16,000 confirmed cases a year.
• Lupus is three times more common in women of color than Caucasian women. Research previews that lupus affects 1 in every 537 African American women.
• A 2014 study found that females who tends to have lupus at a young age, experience serious complications and have a higher death rate.
• Lupus Foundation of America found that lupus was among the top 20 leading source of death in females between the ages of 5-64 ('Lupus facts and statistics, 2016).

References

1. Bertsias, G., & Cervera, R. (2012). Eular.org. Retrieved from https://www.eular.org/myuploaddata/files/sample%20chapter20_mod%2017.pdf.
2. COJOCARU, M., & Doina VRABIE, C. (2011). Manifestations of Systemic Lupus Erythematosus. PubMed Central (PMC). Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3391953/.
3. Conyette, L., Beharry, S., & Dyaanand, H. (2019). CE-34 An analysis of the demographic data in patients with systemic lupus erythematosus in south and central Trinidad. Lupus Science & Medicine. Retrieved from https://lupus.bmj.com/content/3/Suppl_1/A65.
4. How Lupus Affects Your Body. WebMD. (2019). Retrieved from https://www.webmd.com/lupus/guide/how-lupus-affects-your-body#3.
5. Jewett-Tennant, J. (2019). A Quick History of Lupus and Its Implications for You. Verywell Health. Retrieved from https://www.verywellhealth.com/lupus-overview-and-history-of-discovery-2249881.
6. Lupus facts and statistics. Lupus Foundation of America. (2016). Retrieved from https://www.lupus.org/resources/lupus-facts-and-statistics.
7. Lupus - Symptoms and causes. Mayo Clinic. (2018). Retrieved from https://www.mayoclinic.org/diseases-conditions/lupus/symptoms-causes/syc-20365789.
8. M Bartels, C. (2019). Systemic Lupus Erythematosus (SLE): Practice Essentials, Pathophysiology, Etiology. Emedicine.medscape.com. Retrieved from https://emedicine.medscape.com/article/332244-overview.
9. M, A. (2016). [Management of systemic lupus erythematosus]. - PubMed - NCBI. Ncbi.nlm.nih.gov. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/27670650.
10. SB, H. (1992). Systemic lupus erythematosus: medical and nursing treatments. - PubMed - NCBI. Ncbi.nlm.nih.gov. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/1491876.
11. Systemic Lupus Erythematosus (SLE) | CDC. Cdc.gov. (2018). Retrieved from https://www.cdc.gov/lupus/facts/detailed.html.